HomeMy WebLinkAbout805 S Shields St - Applications/Tenant Finish - 07/15/2019City of Fort Collins COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
28TN. College Ave. •Fort Collins, CO 80524 *'Phone: 970.416.2740 • www.fceov.com/building
BUILDING PERMIT APPLICATION
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APPLICATION NUMBER: 2I l gy G I I O APPLICATION DATE: —1 I S
Job Site Address &OS �, rjKlE Unit#
PROPERTY OWNER INFO: All owner informatitiri is required —NOT optional)
Last Name
Ly.g4AAGAAI �0*"P"�First N fEbTR.Y Middle
Street Address S, SK6C%.Db City 1:004T C` 0%AL tftA-, State Zip TC67�
Phone# 910- w%Z-7.1Lb0 Email %XQYl4 am grig4,�,�,pM�
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Name of Business (COMMERCIAL USE ONLY) �•.";y4ElAaI e4a-.1111I
CONTRACTOR INFO: Company Name {li1LsDE C0o7 &%QC r P4
License Holder Name !�EAP3 *.01,1AS LIC # R '1L3 CERT # t` j1-&
LEGAL INFO:
Subdivision/PUD Filing # Lot #
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement)
Residential Sq Ft Commercial•Sq Ft LgDS # of Stories
1st Floor Sq Ft k,%M 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft -% # of Bedrooms
Block # Lot Sq Ft
Total Garage Sq. Ft.
_Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
% Baths % Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck El UA (ResCheck) El SPA(Simulated Performance ❑ Prescriptive[] E RI (Energy Rating Index) ❑
Alternative)
Air Conditioning? YES 'X NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas X Electric ❑ Electric Temp. Pedestal Yes ❑ No
Electric Main Breaker Size (Residential Only): 150 amp or less ❑ 200 Amp ❑ Other ❑
ZONING INFO: (COMMERCIAL USE ONLY
Proposed Use: (i.e. medical, office, bank, retail, etc.) M %MWEW 0m `as
For Commercial remodels and tenant finishes. please answer the following questions:
Is the remodel/tenant finishes for an existing or new tenant? (Please check one)
Existing Tenant New Tenant❑
If for a new tenant, is this the first tenant to occupy this space?
Yes ❑ No ❑ If not for the initial tenant for this unit, what was the previous use of this tenant space?
Are there any exterior building changes (including mechanical) associated with the work? Yes X No ❑
If yes, please describe: SMc.%11 A®®t7tto f Mpg. rebilll'7L7w►, 'S� l•a(�.
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Value of Construction (materials and labor): $ y LAI
Description of Work: I N-rF.Upj. IL,EA,4&fit. , S^4y., S%.r "tak- ExPA0—'VW(W
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JOBSITE SUPERVISOR CONTACT INFO: Name Phone,
SUBCONTRACTOR INFO: Electrical I1LA9AA Mechanical tRCbw.ftAT
Plumbing RpgUog W)g � Framing VAIlLSjbS, Roofing
Fireplace Solar NIA Other
"ASBESTOS STATEMENT DISCLOSURE: In accordance with the State of Colorado Senate Bill 13-152, property owners, applying for a
remodel permit, shall indicate their awareness about their property having been inspected for Asbestos Coniaining-Mdterials,(ACM's).
❑ I do not know if an asbestos inspection has been conducted on'this property.
An asbestos inspection has been conducted on this property on or about (enter date) IzL.0%
❑ An asbestos inspection has not been conducted on this property. ' ' '
Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to
comply with all requirements contained herein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Type or Print Name ZOE M4 1—aG
Phone# g� ` 61s�` ( Z. Email SCd4elS o ►'1 ��S��eC.O�� •Crb��
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE